In Fond Memory of the Status Quo

"If people vote yes, whatever form that takes, that is going to be a vote for health care reform. And I don't think we should pretend otherwise. ... If they don't, if they vote against it, then they're going to be voting against health care reform and they're going to be voting in favor of the status quo."
 - President Obama, during an interview with Fox News's Bret Baier
My mother-in-law died last month. She was 89.

Over the course of her life, as my husband would say, "Mom just couldn't catch a break." She lost 95% of her hearing when she was a young girl. She was widowed at 50 when her husband passed away from complications of a congenital heart defect -- a defect that is routinely repaired in infancy today. She then began working as a nurse's aide for the county. She dreamed of retiring and traveling. A scant year or so after she turned 65, she developed macular degeneration and quickly became legally blind. Then, one day while she was walking with her sister, she didn't see a puddle of oil in a parking lot. The nasty broken ankle never healed right. For the past few years, she hadn't been able to walk. For two years, she couldn't even stand unaided. She lived in a nursing home the last five years.

She was also sharp as a tack and funny as heck. She participated in every activity at the nursing home she was capable of. (I would have paid admission to watch my blind mother-in-law at wheelchair bowling.) She was so good at Tuesday Trivia that the activities director would ask her to please give someone else a chance. She kept all of us in stitches. During a recent hospitalization, which had sadly become more frequent the past few months, she told my husband that her Bible Study teacher had come to visit. "You know," she confided, "I think he's a Christian!"

Lest anyone think that she and I had some kind of fairy tale relationship, let me assure you that there were times when she drove me crazy, such as when she sweetly asked if all my sisters also "got fat after they had babies." But those times were the exception, easily forgiven when I would take into account the almost fierce love she had for her children and grandchildren. As her granddaughter said at the funeral, "Grammy believed in me even when I didn't believe in me."

As my husband and I flew back home, I thought about Jane Sturm, the lady who asked President Obama at a White House health care forum about her mom, who at age 100 had a pacemaker inserted. Ms. Sturm asked Obama, "Outside the medical criteria for prolonging life for somebody elderly, is there any consideration that can be given for a certain spirit, a certain joy of living, quality of life? Or is it just a medical cut-off at a certain age?"

The President replied, "I don't think that we can make judgments based on people's spirit. That would be a pretty subjective decision to be making." Then, in a truly stunning display of both elitism and medical ignorance the, President said,

Loading up on additional tests or additional drugs that the evidence shows is not necessarily going to improve care, that at least we can let doctors know and your mom know that, you know what? Maybe this isn't going to help. Maybe you're better off not having the surgery, but taking the painkiller.

When my mother-in-law was about 80 years old, she started falling. At the time, she was living in a small house next to her daughter. Concerned, they made an appointment with her physician. Suspecting a heart rhythm problem, he had Mom wear a Holter monitor for a couple days at home to record her heart rhythm. In true Murphy's Law fashion, she had nary a spell as long as she was wearing the monitor. Finally, after several appointments and a trip to the ER, the heart rhythm problem was caught on the EKG, and it was obvious that Mom needed a pacemaker. Mom had the surgery, her Medicare Advantage covered it, and that was that.

Except -- Mom was eighty. At the time, deciding to have the pacemaker inserted was a no-brainer. She was mentally sharp, living with minimal assistance and no chronic disease except a little high blood pressure. One could say that she had "a certain spirit, a certain joy of living, quality of life." According to the medical status quo, Mom met the Medicare criteria to receive a pacemaker. Her physician agreed.

But Obama's health care reform is all about "evidence-based" medicine. As he told Jane Sturm, he didn't like "subjective" decision-making. HR 3590 in section 3403 establishes a Medicare Advisory Board which, among other things, would:

give priority to recommendations that extend Medicare solvency; ... ‘‘(I) improve the health care delivery system and health outcomes, including by promoting integrated care, care coordination, prevention and wellness, and quality and efficiency improvement; and
‘‘(II) protect and improve Medicare beneficiaries' access to necessary and evidence-based items and services ...

So in the brave new world of Obama non-subjective decision making, how does my mother-in-law measure up? On paper, she was a train wreck waiting to happen: Legally blind. Nearly deaf. Mobility problems. High blood pressure. Forty-pack-a-year smoking history. Three siblings died of heart disease. Crippled with arthritis of the spine. "Wellness" was never going to be part of her picture. If the Medicare Advisory Board is looking to extend Medicare solvency, the last recommendation they'll make is to implant pacemakers in 80-year-old grandmas.

After his health care bill was passed, President Obama mocked the fears of conservatives because no one had yet "pulled the plug on Granny." But it's a very short distance between pulling a plug and denying a pacemaker. Without that pacemaker, Mom would have died nine years ago. I realize that it's way past time for us to grapple with the difficult issues of the expense and allocation of our health care resources. (For myself, I like what Congressman Paul Ryan is proposing, along with tort reform.) But nine years ago, the decision to get that pacemaker was made by Mom, her doctor, and her family. In a few years, barring repeal of health care reform, we'll all be objective data on an approved health plan spreadsheet. No more diagnosing or prescribing. Data in, decision out. Here's your painkiller. RIP, status quo.

Carol Peracchio is a registered nurse.
"If people vote yes, whatever form that takes, that is going to be a vote for health care reform. And I don't think we should pretend otherwise. ... If they don't, if they vote against it, then they're going to be voting against health care reform and they're going to be voting in favor of the status quo."
 - President Obama, during an interview with Fox News's Bret Baier
My mother-in-law died last month. She was 89.

Over the course of her life, as my husband would say, "Mom just couldn't catch a break." She lost 95% of her hearing when she was a young girl. She was widowed at 50 when her husband passed away from complications of a congenital heart defect -- a defect that is routinely repaired in infancy today. She then began working as a nurse's aide for the county. She dreamed of retiring and traveling. A scant year or so after she turned 65, she developed macular degeneration and quickly became legally blind. Then, one day while she was walking with her sister, she didn't see a puddle of oil in a parking lot. The nasty broken ankle never healed right. For the past few years, she hadn't been able to walk. For two years, she couldn't even stand unaided. She lived in a nursing home the last five years.

She was also sharp as a tack and funny as heck. She participated in every activity at the nursing home she was capable of. (I would have paid admission to watch my blind mother-in-law at wheelchair bowling.) She was so good at Tuesday Trivia that the activities director would ask her to please give someone else a chance. She kept all of us in stitches. During a recent hospitalization, which had sadly become more frequent the past few months, she told my husband that her Bible Study teacher had come to visit. "You know," she confided, "I think he's a Christian!"

Lest anyone think that she and I had some kind of fairy tale relationship, let me assure you that there were times when she drove me crazy, such as when she sweetly asked if all my sisters also "got fat after they had babies." But those times were the exception, easily forgiven when I would take into account the almost fierce love she had for her children and grandchildren. As her granddaughter said at the funeral, "Grammy believed in me even when I didn't believe in me."

As my husband and I flew back home, I thought about Jane Sturm, the lady who asked President Obama at a White House health care forum about her mom, who at age 100 had a pacemaker inserted. Ms. Sturm asked Obama, "Outside the medical criteria for prolonging life for somebody elderly, is there any consideration that can be given for a certain spirit, a certain joy of living, quality of life? Or is it just a medical cut-off at a certain age?"

The President replied, "I don't think that we can make judgments based on people's spirit. That would be a pretty subjective decision to be making." Then, in a truly stunning display of both elitism and medical ignorance the, President said,

Loading up on additional tests or additional drugs that the evidence shows is not necessarily going to improve care, that at least we can let doctors know and your mom know that, you know what? Maybe this isn't going to help. Maybe you're better off not having the surgery, but taking the painkiller.

When my mother-in-law was about 80 years old, she started falling. At the time, she was living in a small house next to her daughter. Concerned, they made an appointment with her physician. Suspecting a heart rhythm problem, he had Mom wear a Holter monitor for a couple days at home to record her heart rhythm. In true Murphy's Law fashion, she had nary a spell as long as she was wearing the monitor. Finally, after several appointments and a trip to the ER, the heart rhythm problem was caught on the EKG, and it was obvious that Mom needed a pacemaker. Mom had the surgery, her Medicare Advantage covered it, and that was that.

Except -- Mom was eighty. At the time, deciding to have the pacemaker inserted was a no-brainer. She was mentally sharp, living with minimal assistance and no chronic disease except a little high blood pressure. One could say that she had "a certain spirit, a certain joy of living, quality of life." According to the medical status quo, Mom met the Medicare criteria to receive a pacemaker. Her physician agreed.

But Obama's health care reform is all about "evidence-based" medicine. As he told Jane Sturm, he didn't like "subjective" decision-making. HR 3590 in section 3403 establishes a Medicare Advisory Board which, among other things, would:

give priority to recommendations that extend Medicare solvency; ... ‘‘(I) improve the health care delivery system and health outcomes, including by promoting integrated care, care coordination, prevention and wellness, and quality and efficiency improvement; and
‘‘(II) protect and improve Medicare beneficiaries' access to necessary and evidence-based items and services ...

So in the brave new world of Obama non-subjective decision making, how does my mother-in-law measure up? On paper, she was a train wreck waiting to happen: Legally blind. Nearly deaf. Mobility problems. High blood pressure. Forty-pack-a-year smoking history. Three siblings died of heart disease. Crippled with arthritis of the spine. "Wellness" was never going to be part of her picture. If the Medicare Advisory Board is looking to extend Medicare solvency, the last recommendation they'll make is to implant pacemakers in 80-year-old grandmas.

After his health care bill was passed, President Obama mocked the fears of conservatives because no one had yet "pulled the plug on Granny." But it's a very short distance between pulling a plug and denying a pacemaker. Without that pacemaker, Mom would have died nine years ago. I realize that it's way past time for us to grapple with the difficult issues of the expense and allocation of our health care resources. (For myself, I like what Congressman Paul Ryan is proposing, along with tort reform.) But nine years ago, the decision to get that pacemaker was made by Mom, her doctor, and her family. In a few years, barring repeal of health care reform, we'll all be objective data on an approved health plan spreadsheet. No more diagnosing or prescribing. Data in, decision out. Here's your painkiller. RIP, status quo.

Carol Peracchio is a registered nurse.